Eugene Koh, MD, PhD, associate professor in the department of orthopedics at Baltimore-based University of Maryland School of Medicine and chief of orthopedic spine at Baltimore VA Medical Center, discusses the future of orthopedic surgery and where technology trends are headed.
Question: What emerging technology or technique do you think will have the biggest impact on the spine field five years from now?
Dr. Eugene Koh: The biggest impact on the field of spine surgery over the next five years will come from robotic-assisted surgery in combination with artificial intelligence. This powerful combination would allow for more accurately placed spinal instrumentation, lower the intraoperative radiation exposure to the patient and the surgeon and aid in determining angular correction to assess sagittal balance intraoperatively.
The addition of artificial intelligence technology would advance the current robotic/navigation technology to adapt easily to intraoperative changes in the spinal anatomy that differ from preoperative images from X-rays, CT scans and MRIs. The current systems are sensitive to any changes in the calibration markers as well as modifications to the spinal anatomy, like interbody devices. Artificial intelligence would allow for the system to adapt with minimal recalibration.
Q: What do you think will fade or disappear from the spine field over the next few years?
EK: Currently, insurance companies are collecting data on each individual surgeon, including expense for each individual procedure (for example, the cost for a single-level ACDF). Certain insurance companies are financially incentivizing primary care physicians to refer to the least expensive surgeons. As they accumulate more data, including outcomes data, the insurance companies would dictate the procedure or surgeon with the lowest revision rate. Numerous reports have demonstrated interspinous devices for lumbar spinal stenosis have poor outcomes and a high re-operation rate. Insurance companies will make it more and more difficult for surgeons to justify placing these implants or any devices that have a high revision rate.
Q: Where do you see the biggest room for innovation in spine? What do you need to provide better care that doesn't currently exist?
EK: Biologics is a critical area for innovation in spine. The bane of spinal fusions is pseudarthrosis. Significant research is being placed on finding the next BMP-2 without the wide range of side effects. The Holy Grail is regenerative medicine technology with the goal of restoring the degenerative disc without need for a fusion surgery or artificial disc replacement surgery. Currently, the hype and the hope of stem cells, however, has failed miserably short of the goal of regenerative medicine. We are far away from succeeding, but many are actively researching the basic science barriers and advances to accomplish this goal.
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For a deeper dive into the future of spine, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-5, 2019. Click here to learn more and register.